| NPI | 1669144192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5556493-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5556493-8911) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2021-10-04 |